Robert A. Vaneenwyk, D.D.S.
Individual provider Active NPI General Practice Dentistry · Bergen, NY
NPI 1154478253 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154478253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 033242 (NY)
- Practice address
- 26 S Lake Ave
Bergen, NY 14416-9734 - Phone
- (585) 494-1145
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033242 | NY | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 033242 | NY | Yes |
Addresses
Primary practice location
26 S Lake Ave
Bergen, NY 14416-9734
Mailing address
26 S Lake Ave
Bergen, NY 14416-9734
Phone (585) 494-1145
Other providers in Bergen, NY
All providers in Bergen, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.